Provider Demographics
NPI:1740681063
Name:GROGG, HALEY (RRT)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:
Last Name:GROGG
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:B
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:1 HEALTHCARE DR
Mailing Address - Street 2:MANSFIELD HILL
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-9405
Mailing Address - Country:US
Mailing Address - Phone:304-457-1760
Mailing Address - Fax:304-457-3781
Practice Address - Street 1:1 HEALTHCARE DR
Practice Address - Street 2:MANSFIELD HILL
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-9405
Practice Address - Country:US
Practice Address - Phone:304-457-1760
Practice Address - Fax:304-457-3781
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVLRTR1531227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered